There's no hospital in Atka, Alaska. There's not one in Metlakatla, Mountain Village, St. Michael or Savoonga, either. In these places, immediate medical care might come from somebody's sister, cousin, mother or son —- a graduate of Alaska's Community Health Aide Program.

When traditional medical institutions are unavailable, CHAP aims to fill in the gap.

"It's vital to the communities. They need someone there," said Carolyn Craig, a former health aide, and current CHAP instructor. "For one thing, it's immediate medical care."

Alaska' health aide network dates back to before statehood. Back when Dr. Walter Johnson trained locals in the ways of Directly Observed Therapy to combat an outbreak of tuberculosis. With inadequate medical facilities in Western Alaska, doctors needed another solution.

"We didn't have the infrastructure, but we had a TB epidemic," said Torie Heart, director of the community health aide program at the Alaska Native Tribal Health Consortium. "And that's kind of how the program evolved."

Formalized and funded by Congress in 1968, the Community Health Aide Program now includes approximately 550 health aides working in more than 170 Alaska communities. There are currently training centers in Anchorage, Bethel, Fairbanks, and Nome. Aides often leave their hometowns for weeks at a time while completing training.

Craig's mother-in-law was one of the program's first graduates, and Craig herself worked as a health aide in Takotna and McGrath in the 1980s, she said. After leaving her post as a health aide, she began training others to fill her shoes —- a job she's held since 2005.

"It's a project near and dear to my heart," she said.

Aspiring community health aides must undergo four individual training sessions, a process that usually takes about two years to complete. In between sessions, trainees return to their home communities and practice their newfound skills. They work within the scope of the CHAP manual, Craig said: They learn to take a medical history, perform a simple exam and make an assessment. After session two, a CHA trainee might receive standing orders, allowing them to treat various conditions according to a specific plan.

CHAP students undergo four rigorous training sessions, a process that takes about two years to complete. Photo courtesy of ANTHC.

"It's a very intense program built on didactic and hands-on skills," Craig said.

The program has evolved significantly over the past few years. From its origins as a TB treatment and prevention measure, it has expanded to try and address emergency issues, chronic medical problems, and other preventative work, said Heart, the program director.

Craig still recalls the days when health aides wrote all their records by hand. Now, she said, students are trained to use electronic health records and other modern medical technology.

For patients living in some of Alaska's most remote communities, the health aides can make all the difference. No longer do you need to board two planes and make a full day's journey to treat a simple case of strep throat at a hospital in Anchorage. No longer do you have to leave home overnight for a basic checkup.

But while medicine and technology and education have transformed the health aide network, one thing remains unchanged.

"It's still a village-based program," Heart said.

The CHAP network's strength lies in its strong ties to the communities it serves. Rather than turn to a big-city doctor with limited regional knowledge, patients have the option to receive immediate medical help from familiar people in familiar places. Community health aides usually have personal ties to the places they serve. Their patients are often family.

CHAP is a village-based program and aides are often serving friends and family. Photo courtesy of ANTHC.

"These are their sister's kids, their cousin's kids, their friend's kids. These kids have a face and a name," Heart said. "So the ability to get care locally is highly valued in the tribal health system."

It's so highly valued, Craig said, there's a deep waiting list for CHAP training sessions. Many health aides follow in the footsteps of older relatives, building on a family tradition two or three generations deep. And recently, Craig said, she's seen something else —- people moving up to Alaska with the specific goal of becoming a community health aide. But there's not enough room in the state's four training centers.

"We don't have the ability to train everybody that needs to be trained —- there's a huge backlog in the state," Craig said.

The CHAP experiences a relatively high turnover rate, she said. The work can be exhausting. Health aides are on call 24/7; often alone. They may be called on to care for close relatives, which can carry a steep emotional toll.

But it's a difficult job that makes a massive difference in the health of a community, Craig said. What health aides lack in formal medical training is made up for in local knowledge.

When the training sessions are over, Craig stays in touch with many of her former students. She hears firsthand stories about the work they do, and she sees the impacts they make on the communities around them. It's no small feat."The things that health aids have done over the years as far as saving lives is amazing," Craig said.

This article was produced by the special content department of Alaska Dispatch News in collaboration with ANTHC. Contact the editor, Jamie Gonzales, at jgonzales@alaskadispatch.com. The ADN newsroom was not involved in its production.